Home biofeedback therapy improves fecal incontinence severity

PHILADELPHIA — According to research presented at the American College of Gastroenterology Annual Meeting, biofeedback therapy for fecal incontinence administered with a home-based device was as good as, if not better than, biofeedback administered in an office setting.

Amol Sharma, MD, of Augusta University Medical Center, said that while office-based biofeedback has demonstrated some success, its limitations leaves something to be desired.

“It requires multiple office visits, its labor intensive, it’s time consuming for patients and providers, and leads to loss of work by patients,” Sharma said in his presentation. “And it may not provide durable treatment response.”

With home biofeedback, patients can do the therapy one to two times a day, 6 days a week for 6 weeks. Sharma and colleagues compared home biofeedback (HBT) with standard biofeedback (OBT) in a non-inferiority, randomized controlled study.

Researchers randomly assigned patients with fecal incontinence (> 1 episode per week) to undergo one-hour, weekly sessions for six weeks in the OBT arm (n = 10) or sessions at home (n = 20) using a novel device (InToneMV, InControl Medical). Investigators assessed patients’ daily bowel symptoms, fecal incontinence severity index (FISI), fecal incontinence severity score (FISS), subjective global assessment (SGA) and International Consultation on Incontinence Module Questionnaire-Bowels (ICIQ-B) at both baseline and after treatment was completed.

Sharma and colleagues found that a higher percentage of patients in the HBT arm experienced improvement in SGA (70%) compared with the OBT arm (30%). Four patients in the OBT arm had worse SGA scores after treatment compared with none in the HBT group.

Patients in the HBT group also experience significant increases in FISI score (P = .005), as well as decreases in FISS (P = .006). Although patients in the OBT group experienced improvement in these scores, it was not statistically significant.

Additionally, patients in the HBT group reported significant improvement in all three components of the ICIQ-B (bowel pattern, bowel control, quality of life), whereas patients in the OBT arm experienced improvement in QOL.

“Home biofeedback therapy is a promising, efficacious and cost-effective treatment option for fecal incontinence,” Sharma said. “Further validation of home biofeedback therapy requires a larger, sham-controlled randomized trial.” – by Alex Young

Reference : Sharma A, et al. Abstract 71. Presented at: American College of Gastroenterology Annual Scientific Meeting; Oct. 5-10, 2018; Philadelphia.

Disclosure: Sharma reports no relevant financial disclosures. Please see the study abstract for all other authors’ relevant financial disclosures.